Provider Demographics
NPI:1891829602
Name:THE DOCTOR'S OFFICE, INC.
Entity Type:Organization
Organization Name:THE DOCTOR'S OFFICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-352-7003
Mailing Address - Street 1:6500 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2654
Mailing Address - Country:US
Mailing Address - Phone:314-352-7003
Mailing Address - Fax:
Practice Address - Street 1:6500 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2654
Practice Address - Country:US
Practice Address - Phone:314-352-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6B25208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201567013Medicaid
MO002011039Medicare ID - Type Unspecified
MO201567013Medicaid